Organization
GREAT RESIDENTIAL HOME CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOSEPH BIZIMANA DSP (CEO)
(207) 518-1535
Entity
Organization
Contact information
Practice address
238 AUBURN ST APT D37, PORTLAND, ME 04103-2150
(207) 518-1535
Mailing address
238 AUBURN ST APT D37, PORTLAND, ME 04103-2150
(207) 518-1535
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Enumeration date
12/12/2020
Last updated
12/12/2020
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